COUNTY HOSPITAL PLAN `IGNORES CHANGE`

Many thanks to The Tribune for its hard-hitting editorial on the Cook County Board decision to move ahead with a huge new hospital facility.

The county`s proposal ignores fundamental changes in health care over the last several years, particularly with regard to care for the poor and the medically indigent. Many of these changes were identified by the Metropolitan Planning Council and the University of Chicago`s Center for Urban Research and Policy Studies, in their 1986 report ''Poverty, Illness, and the Future of Cook County Hospital.'' Among those changes are the following:

Numerous procedures that formerly were performed in hospitals now routinely take place in outpatient clinics;

Many hospital procedures now take place over a radically reduced time period;

Experiments conducted in several cities showed the positive effects of preventive care programs in keeping the poor from getting hospitalized in the first place.

These trends led us to recommend that the county decentralize its outpatient system through a coordinated network of community health centers.

If the health of the medically indigent is our concern, we must not care only about how we treat them when they get to the hospital, but also about how to keep them from needing to go there in the first place. We must restructure the system to get health care closer to the poor, so they can be treated earlier in the course of an illness.

The Metropolitan Planning Council asks the County Board to consider the following facts and request answers to the following questions before going ahead with plans for a huge new single hospital facility:

Three options have been outlined for the County Board in the Long Range Master Plan of February, 1987: a replacement hospital of the same size; a smaller facility and the purchase of a second; and service agreements with other facilities.

Why haven`t detailed long-term capital and operating costs of these options been produced and compared? Why haven`t the range of options related to Provident and the University of Illinois Hospital been prepared, costed and compared? (The report notes that 45 percent of County`s admissions come from the South Side.)

It is further noted in the report that improved ambulatory facilities will reduce the demand for hospital beds. Why isn`t the extent of that reduction explained? What would be the extent of reductions if a complete system of ambulatory centers were established? What long-term cost savings might be expected by such a program?

There is no surplus of critical care and emergency beds in the county. However, there are over 3,500 surplus beds in hospitals in the county, many in locations more accessible to those in need. Would there be long-term savings in capital and operating costs to the county of purchasing services from high- quality community hospitals?

It is clear that the existing hospital it must be replaced. However, the options have not been fully analyzed. Further, in light of national trends toward outpatient care, it is grossly unfair to both the poor and the taxpayers to make plans for a new hospital without concurrently establishing an effective outpatient system.